Date: Thu, 23 Mar 2006 20:13:41 -0600
From: "Elle" 
Newsgroups: misc.invest.financial-plan
Subject: Re: variable universal life
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"Chris Cowles"  wrote
> HSAs may have the effect you describe, but third-party 
> payers have *not* driven costs up. They have driven costs 
> *down*.
>
> Working for a large healthcare provider, I can tell you 
> that third-party contracts pay fixed rates per diagnosis, 
> not fee-for-service.

Isn't this a distinction without a difference? If the doctor 
or his/er employer wants more money, s/he just gives a 
diagnosis that seems to fit but may not. And who's going to 
catch it? Diagnosis certainly by its nature is often 
hit-or-miss. Should an insurer not have to pay for a test 
that was negative but in fact was appropriate for the 
symptoms?

And what about the reports that doctors spend less time with 
patients than ever, and that this affects the quality of 
care they can give? They're spending less time with patients 
because their jobs have become the pressure cooker of 
lawyers: It's largely about billable acts. Never mind the 
quality of the acts.

> The incentive is definitely for the provider to cut costs, 
> or lose money.

I think you are omitting the (much reported on) inherent 
conflict of the incentive to incease costs of services (or 
number of services) and so gain money. Medicine is so 
gray--and each individual so unique--that it's extremely 
difficult to identify what a reasonable standard of care is.

Consider:
---NY Times, "Why Doctors So Often Get It Wrong," Feb. 22, 
2006---
Under the current medical system, doctors, nurses, lab 
technicians and hospital executives are not actually paid to 
come up with the right diagnosis. They are paid to perform 
tests and to do surgery and to dispense drugs.
There is no bonus for curing someone and no penalty for 
failing, except when the mistakes rise to the level of 
malpractice.
---
or
---Associated Press, "Health study finds that 'we all get 
equally mediocre care'," March 17
[In a survey of 7000 patients, the biggest study ever of 
U.S. health care].. patients received only 55 percent of 
recommended steps for top-quality care...
 ---

>From a financial planning standpoint, I think the best bet 
for the consumer is preventive maintenance for the body; 
followed by one's own study of one's ailments so as to keep 
a medical plan of action focused; followed by watching 
health insurance and hospital billing very closely, since 
reports are that errors in billing (from insurers and 
hospitals) are routine and often sizable. (Yes, I have 
citations for this too.)